全髋关节置换后早期创伤局部引流血和循环血中的相关细胞因子水平

背景：对于全髋关节置换后创伤早期的应激阶段,创伤局部和全身细胞因子动态变化规律的研究还鲜见报道。目的：观察全髋关节置换后早期无菌性炎症阶段创伤局部引流血和全身循环血中相关细胞因子水平的动态变化。方法：选取行全髋关节置换患者9例,分别在关闭伤口时、置换后1,4和24h采集静脉血样本以及创伤局部引流血液样本;采用酶联免疫吸附法分别测定血清中白细胞介素6,肿瘤坏死因子α,白细胞介素1β和白细胞介素17水平。结果与结论：全髋关节置换后早期创伤局部引流血和循环血中白细胞介素6水平均明显升高,并且在各个时间点上创伤局部引流血中白细胞介素6水平均高于循环血（P〈0.05）;置换后早期循环血中肿瘤坏死因子α水平明显升高,创伤局部引流血肿瘤坏死因子α的水平无明显变化,但仍高于循环血中的水平（P〈0.05）;白细胞介素1β和白细胞介素17的水平在置换后无显著改变,且在创伤局部和循环中的含量无显著性差异。结果提示在全髋关节置换后急性无菌性炎症阶段,循环血中炎性细胞因子的水平不会直接反映局部的炎症反应。

Systemic and local cytokines kinetics in early stage after total hip replacement

BACKGROUND：Studies about local and subsequent systemic inflammtatory reactions in early stage after total hip replacement are rarely reported.OBJECTIVE：To investigate the local and systemic cytokine kinetics in early stage after total hip replacement.METHODS：In 9 patients undergoing total hip replacement,drained blood samples and venous blood samples were taken at wound closure,1,4 and 24 hours after operation.Interleukin 6（IL-6）,tumor necrosis factor alpha（TNF-α）,IL-1β and IL-17 release was assessed by enzyme-linked immunosorbent assay（ELISA）.RESULTS AND CONCLUSION：The major findings were significant increases in systemic levels of IL-6 and TNF-α and in local levels of IL-6,and the local levels of these cytokines were significantly higher than the systemic ones after operation（P 0.05）.Besides,there were no significant changes in local and systemic levels of IL-1β and IL-17.The acute sterile inflammation after major orthopaedic surgery is principally characterized by significantly increased local and systemic levels of IL-6.Furthermore,the systemic cytokine levels may not reflect local reactions.